Nachsorge nach Blasenersatzoperationen^[*]

Zusammenfassung

Ein Blasenersatz wird zumeist nach radikaler Zystektomie wegen eines Urothelkarzinoms der Harnblase erforderlich. Neben der Tumornachsorge (lokales, urethrales und systemisches Rezidiv, Tumorauftreten im oberen Harntrakt) ist eine funktionelle Nachsorge der Harnableitung erforderlich. Die diesbezüglichen Leitlinienempfehlungen sind noch lückenhaft. Durch lange Kontaktzeit und große Oberfläche in kontinenten Pouches aus Darmsegmenten kann die Resorption von Harnbestandteilen zu Elektrolytstörungen und Azidosen führen. Entscheidend für die Kompensation ist die Nierenfunktion. Die Ausschaltung langstreckiger Ileumsegmente aus der Darmpassage kann zu Malabsorption von Vitamin B₁₂ und Gallensäuren führen. Jeweils bis über 30 % der Langzeitüberlebenden nach Zystektomie mit kontinenten Ersatzblasen substituieren Bicarbonat und Vitamin B₁₂. Besondere Aufmerksamkeit ist auch dem oberen Harntrakt, der Nierenfunktion und der Entwicklung von Sekundärmalignomen zu widmen. Sekundärmalignome treten gehäuft in Sigma-Rektum-Pouches, Blasenaugmentationen und Ersatzblasen mit Inkorporation von Kolonanteilen auf. In der Nachsorge ist es wichtig, die spezifischen Komplikationsmöglichkeiten der verschiedenen Harnableitungsformen zu berücksichtigen.

^* Erstpublikation: Akt Urol 2013; 44: 55–67

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